Numerous indicators of the well-being of our children and families paint a mixed picture of successes and shortcomings. Our national infant mortality rate is declining rapidly and is at a record low, but is still higher than that of many other countries. Our children's test scores in reading and science are improving but still trail those of several other industrialized nations. Our school dropout rate is unacceptably high, costing over $250 billion each year in lost earnings and foregone taxes, as well as lost human potential. Our teenage pregnancy rate is declining slightly, but is still the highest in the developed world. Our national vaccination coverage is the highest ever, but in many communities less than 50 percent of two-year-olds are adequately immunized. A similar picture of gains and unmet goals exists with respect to youth violence, child poverty, smoking, and other substance abuse.

Much of the progress achieved in these and other areas is the result of critical research efforts that have advanced our understanding of how children and youths develop into healthy and productive individuals. Research has helped to inform policy decis ions and program development, track outcomes, and identify strategies that work and those that do not. The Federal investment in research has clearly paid dividends in terms of improved outcomes for children and a healthier and brighter outlook for the entire Nation. Despite such important achievements, much remains to be done: Significant gaps persist in our understanding of how children grow up to be healthy, well-educated, and responsible members of society. Given the profoundly changing nature of our communities and Nation, strengthening the Federal research enterprise on child and adolescent development and expanding its role in shaping relevant policy are especially crucial to serving national goals.

The Children's Initiative Subcommittee

• Assess the size and scope of the Federal research portfolio on children and adolescents;
• Identify important research issues in children?s biological, cognitive, and social development; and
• Strengthen research-policy linkages and develop a sustainable process for collaboration and communication of scientific knowledge about childhood and adolescence within the Federal Government.

The Federal Research Portfolio

Important Research Issues and Opportunities

• Health and Behavior. With increasing recognition of the major impact of behavior on health, important research questions include what influences children to avoid or engage in risky and adverse behaviors, the nature of the health behavioral change process for children and youth, the cumulative effects of adverse and risky behaviors on child development, age group differences in health risk behaviors, influences of family and situational factors on health risk behaviors, how children and adolescents perceive the risks of engaging in health compromising behaviors, and what approaches would help them adopt health enhancing behaviors.

• Children and Environmental Hazards. With children facing a wide array of environmental threats to their health, it is important to learn how best to understand the health implications of these threats, understand the cumulative effects of hazardous substances, identify hazards that are particular threats to children, and learn when children are most vulnerable to these hazards.

• Learning. New knowledge about the brain processes involved in learning provides opportunities to study the relationships between learning and intelligence and creativity, the use of technology to nurture the ability of children to learn and create, the effects of multimedia technologies on children's development, and the role of nutrition in influencing ability to learn.

• Influence of Families and Communities on Development. Important questions include how children and families access community resources and find out about their availability, how communities can facilitate an adolescent's safe passage to adulthood, how changing families and communities are affecting children and adolescents, and how families and communities as well as children are being affected by major policy innovations taking place at all levels of government.

• Longitudinal Studies. Long-term follow-up studies of children provide the best means for assessing how child development in "normal" conditions compares to what occurs in adverse conditions, how families and social institutions can help children become economically productive adults, how childhood experiences affect later adult behavior and risks of chronic disease, and how childhood and adolescent interventions can be most effectively targeted to the childhood antecedents of adult disease to prevent or delay onset of problems in adult life. To achieve the latter objective, studies could address interventions during childhood to reduce the likelihood of osteoporosis, cardiovascular disease, obesity, injury, smoking, mental health problems, learning disabilities, AIDS, and other conditions.

• Policy Research. In this emerging field of research, important questions to address are the effects of variations in health care and welfare reform on children and families, the combined effect of policy changes on child well-being and service delivery, approaches to prevention and intervention that best foster health and well-being of children, and data sources needed to monitor change.

Linking Research to Policymakers and
Service Providers

Given the complexity of influences on child and adolescent development, improved connections between researchers and those who develop policies and programs concerning the future of young people must be an essential part of the Federal research strategy. These connections should be thought of in terms of a continuing feedback system, with multiple entry points for feedback and modification in the decisionmaking process at the Federal, State, and local levels. Such a strategy would enable researchers not only to inform initial policy and program development, but also to monitor and evaluate the implementation of these policies and programs -- and their effects on child, adolescent, and family status -- on an ongoing basis. Sustained research could provide knowledge that is essential in our effort to further shape and refine policies and programs so that they more effectively address the problems facing our children and Nation.

Increased multi-agency collaboration and coordination of research on national priorities related to children's health, education, and well-being are essential steppingstones to success. Just as linkages should cut across public and private sectors and span all governmental levels, the Federal Government's collaborative approach should also strive to tap the knowledge and experiences of the private sector, including foundations and private industry. Strategic partnerships with interested public and private sources will be instrumental to addressing the current and emerging needs for relevant data and knowledge concerning children and adolescents.

A specific linkage issue is how the Federal research investment in child and adolescent development can be more effectively used to inform our Nation's domestic policy. Two fundamental questions are involved. The first is how to create and strengthen the linkage between two key councils within the Executive Office of the President -- the National Science and Technology Council (NSTC) (which coordinates the diverse parts of the Federal research and development enterprise) and the Domestic Policy Council (DPC) (which oversees the development and implementation of the President's domestic policy agenda), in a way that fosters important research and uses the results of that research to guide policy development. The second is how to use this linkage between NSTC and DPC to create effective collaboration among Federal agencies that support research on children and adolescents.

Recommendations for Next Steps

• Provide directly to the NSTC and DPC on an ongoing basis -- the results of Federal research activities that relate to these goals and have implications for policy.

• Develop and implement a long-term strategic planning process -- to advance a multi-agency Federal R&D effort related to the optimal development of children and adolescents. This process should include the identification and recommendation of appropriate partnerships among public and private sector parties interested in ensuring the healthy and productive development of children and adolescents.

• Identify key research investment opportunities regarding children and adolescents -- to achieve the overarching goals outlined in the strategic plan. These investment opportunities should highlight the need for and the benefits of a multi-agency, coordinated approach to scientific research concerning young people. The Office of Science and Technology Policy (OSTP) and the Office of Management and Budget (OMB) would play an integral role in working with the IWG to develop a coordinated strategy, including budgetary issues, in which agencies can collaborate on research problems of national concern. These problems include strengthening the collection of reliable indicators of child and adolescent well-being and the research that provides us with knowledge of the factors that influence these indicators over time. A coordinated research strategy on optimal human development from early childhood into young adulthood, particularly on factors supporting learning, should be a high priority.

• Identify mechanisms to strengthen research-policy linkages -- not only among NSTC, DPC, Federal agencies and State and local government, but also among relevant non-governmental organizations and other public and private sector parties at the national, regional, and community levels. Such extensive linkages are needed to ensure that research knowledge generated by Federal agencies and other entities are effectively used to inform policy and program development regarding children, youth, and families.

• Consider appropriate means for conducting an external assessment of the IWG's work -- to ensure that the Federal Government's strategic plan and identification of key research investment opportunities, potential important partnerships, and mechanisms for strengthening research-policy linkages regarding children and adolescents are on target and effective.

Our Nation has a clear stake in ensuring that all of America's children grow up to be healthy, educated, productive, and contributing adults. Doing so requires removing barriers to achieving their full potential, including the barrier of insufficient knowledge. Scientific research is and will continue to be a catalyst for achieving that goal; it serves as a fundamental tool to gain knowledge needed for informing, developing, implementing, and refining policies and programs that address the urgent needs of children and adolescents. As such, research must be at the forefront of the highest level of decisionmaking. The Federal Government is faced with an opportunity to embark on a path that will lead to creating and sustaining conditions that optimize human development. It is time to take that first step -- to establish a coordinated multi-agency research approach that emphasizes partnerships among the public and private sectors and linkages between the research and policymaking communities. We owe our children, our families, and our Nation nothing less than this sound investment in our future.

At the same time, too many of our children, adolescents, and their families face obstacles that obscure that bright future, including poverty, violence, child abuse, inadequate education, and substance abuse. Addressing these challenges to their future and investing in opportunities to ensure that all children reach their full potential is a central priority of the Administration. The devastating economic and social costs of not responding to these challenges for both individuals and society are indisputable.

The Administration's commitment to children and youth was demonstrated in its first term. It launched a number of initiatives critical to children and youth, including increasing Head Start enrollment by almost 200,000 in 1997, curbing the sales and marketing of tobacco to children (the Children's Tobacco Initiative); reducing teen pregnancy rates; providing safer food and drinking water; and expanding opportunities for children to improve their skills, maximize their potential, and prepare for the 21st century workplace (the Educational Technology Initiative, the America Reads Initiative).

Due in part to these efforts and the President's commitment to "cherish our children and strengthen the American family," the Nation has taken some modest but significant steps toward addressing these daunting challenges. Progress in these areas must often be measured incrementally. Solutions and knowledge of their effects and influence often take years or even generations to emerge. Still, it is important to acknowledge our successes. For example:

Infant Mortality2
What We Have Accomplished:	The infant mortality rate reached a record low of 7.5 infant deaths per 1,000 live births in 1995, a 6 percent decrease from the previous year.
Challenges that Remain:	The U.S. still has one of the highest infant mortality rates of any developed country; in some urban areas it exceeds some developing countries. From 1985 to 1994, the rate of low birth weight babies steadily increased. Low birth weight infants account for nearly two-thirds of all deaths under 28 days of age; those babies who survive are at increased risk of suffering severe physical and developmental complications.
Education3
What We Have Accomplished:	American fourth graders outperformed students from all other nations, except Finland, in the latest International Assessment of Reading, while American eighth graders have demonstrated rising math and science scores in recent years.
Challenges that Remain:	Despite our national goal of being first in the world in math and science by the year 2000, U.S. eighth graders scored below the average of 41 countries in the math portion of the 1995 Third International Mathematics and Science Study (TIMSS). In science, students in nine countries outperformed U.S. eighth graders. In 1994, 40 percent of fourth graders failed to attain the basic reading level, while 70 percent did not attain the proficient level (i.e., competency with challenging reading materials). Poor reading performance is an important predictor of school dropout. Each year's class of dropouts will, over the course of its lifetime, cost the Nation about $260 billion in lost earnings and foregone taxes, in additional to lost human potential.
Teen Pregnancy4
What We Have Accomplished:	The teen birth rate declined in 1995 for the fourth straight year, while the unmarried birth rate has decreased for the first time in nearly two decades.
Challenges that Remain:	The teen birth rate is still higher than it was 20 years ago and the U.S. rate remains the highest in the developed world. Every year about one million adolescents become pregnant, most of whom are unmarried teens.
Immunization 5
What We Have Accomplished:	In 1995, three-quarters of all two-year-olds were fully immunized -- a historic high. The incidences of Haemophilus influenzae type b invasive disease, symptomatic hepatitis B, and measles among infants in the highest-incidence groups have been reduced by over 95 percent.
Challenges that Remain:	Vaccine coverage among the economically disadvantaged in inner-city areas is about 50 percent. Public health measures require an immunization rate of 80 to 90 percent of all children to prevent the spread of outbreaks.

Much of the progress achieved in these and other areas is grounded in critical research efforts that have advanced our understanding of how children and youth grow into healthy and productive adults. Research has helped to inform policy decisions and program development, track outcomes, and identify strategies that work and those that do not. The Federal investment in research has clearly paid dividends in terms of improved outcomes for children and a healthier and brighter outlook for the Nation as a whole.

Consider, as examples, the pivotal role research has played in the development of early childhood education, the reduction and prevention of childhood lead exposure, the reduction and prevention of childhood injuries and iron deficiency anemia, the identification of protective factors that help children overcome adverse conditions such as poverty, and the understanding of how child nutrition contributes to health and educational attainment (see box).

Despite such important achievements, the Federal emphasis on research must be sustained. There continue to be significant gaps in our understanding of how children grow up to be healthy, well-educated, and responsible members of their communities and nation. Coordination across the Federal Government as well as among Federal, State, and local governments needs to be improved. Linkages between researchers and policymakers must be strengthened. And changes in policy must be informed by policy-relevant research and assessments. These challenges must be addressed if our Nation is to develop policies and programs that meet the complex needs of today's children and youth. Strengthening the Federal research enterprise on child and adolescent development and its role in shaping relevant policy is especially crucial given the changing nature of our communities and Nation.

The United States is experiencing significant changes in the racial and ethnic diversity of its population, fundamental shifts in the structure of families, and an increasingly global economy that demands a highly skilled workforce to achieve an adequate standard of living. At the same time, our society is undergoing changes in longstanding social policies; these changes include the devolution of responsibility for income support programs (e.g., welfare) from Federal to State Governments and the restructuring of our health care financing system. Our Nation has learned how to invest in and profit from research; now we must extend those efforts to meet the challenges of the next century.

Maximizing the Nation's Investment:
Essential Research-Policy Linkages

To achieve meaningful progress, research on children and adolescents must be used more effectively to inform our Nation's domestic policymakers. This means the scientific community must better communicate and disseminate significant research findings to policymakers. Policymakers, too, must work with researchers to help identify key questions concerning children, youth, and families that need to be addressed through research.

Understanding the forces that shape young people's development and using that knowledge to influence public policy and service delivery should be a cornerstone of the Federal Government's research enterprise. An example of the successful potential of this process is described in the box in this section. To neglect this fundamental building block risks compromising national goals of security, economic prosperity, and high quality of life for all.

About This Report

While Investing in Our Future: A National Research Initiative for America's Children for the 21st Century provides several examples of important research issues concerning children and adolescents, a dynamic research framework and agenda is needed that would involve partnerships among research and policy groups in the Federal Government, in collaboration with non-governmental researchers and practitioners. This report should be considered the first phase of a sustained effort directed towards that end.

Organization of Report

Section II, Gaps in the Knowledge Base: Examples of Research Opportunities, provides examples of research needs in understanding children's biological, cognitive, and social development, and a basis for establishing research priorities.

Next, Section III, A Key Element of the Research Enterprise: Links to Policymakers and Service Providers, discusses the need for establishing stronger links among researchers, policymakers, and service providers to develop policies and programs that meet the needs of children and adolescents.

The report concludes with Section IV, Next Steps: Options for Phase Two of the Children's Initiative, which provides recommendations for building on the work of this first phase.

The Current Federal Investment

The CTI analysis aimed to estimate the Federal portfolio; it is not a comprehensive, in-depth examination of each Federal R&D project related to child and adolescent development.

CTI found that, in fiscal year (FY) 1995, the Federal Government spent an estimated $2 billion on R&D directly related to children and youth. These funds were distributed among 12 Federal departments including eight agencies within the U.S. Department of Health and Human Services (HHS) and 21 funding components within the National Institutes of Health (NIH) and three independent Federal agencies. The National Institute of Child Health and Human Development (NICHD), the National Institute of Mental Health (NIMH), and the Department of Education (ED) account for about half of the research. However, each of the 15 Federal departments and independent agencies has a specific mission for its R&D efforts, which is often linked closely to its service programs, and provides valuable findings to enhance the knowledge base about children and adolescents. A key challenge lies in collecting, analyzing, and synthesizing what this knowledge base tells us about what the Nation can do to ensure the healthy development of all American youth.

There are several ways to put in perspective the estimated $2 billion Federal R&D investment in children and youth. One way is to compare this investment to the total Federal R&D budget, which includes research on defense, energy, health and other topics. Such a comparsion shows that Federal R&D on children represents less than three percent of the total Federal research investment of $71 billion, and about six percent of the $33 billion non-defense R&D budget (Chart 1).

It is equally important to place children's R&D in the context of the Nation's total R&D expenditure--including all levels of government and the private and nonprofit sector. The private and nonprofit sectors provide more total R&D funding than the Feder al Government--an estimated $100 billion in FY95. However, little of this private and nonprofit research is directed toward research on children (excluding product-oriented marketing research). Foundations spent an estimated $75 million on research for children in FY95, and the remaining nonprofit sector and State and local governments probably contributed less than $300 million. Thus, the share of total national R&D directed toward children is less than 1.2 percent.

Unlike other areas of research, the Federal Government bears almost total responsibility for R&D on children. For instance, the private sector provides over 50 percent of health and energy R&D funding and over 90 percent of transportation R&D. In contra st, the Federal Government provides approximately 90 percent of children's R&D. Thus, it is even more essential that the Federal research portfolio be well coordinated across agencies and adequate to address the critical social, educational and health is sues facing children.

A second way to consider the investment in R&D for children is as a proportion of total expenditures on children. The U.S. investment in R&D is between 2 and 3 percent of national expenditures (Gross Domestic Product, or GDP). In the areas of health, en ergy and transportation, the Nation invests between 2 and 3 percent of expenditures in R&D. This R&D commitment of 2 to 3 percent is directed toward making the expenditures in each area more effective and efficient.

In contrast to the 2 to 3 percent commitment in other areas, less than three-tenths of a percent of the expenditures on children is spent for R&D on children. Total government expenditures for children and youth in FY1995 were an estimated $555 billion, almost two-thirds of which was devoted to K-16 education. Most of the remaining funds were allocated for social welfare (including AFDC, Medicaid, Head Start, WIC, and Food Stamps), criminal justice (including police, courts, and prison expenditures), health care, and other programmat ic expenses (Chart 2). Private sector expenditures for children are far larger than public sector expenditures, so our total R&D commitment to children of $2 billion to $2.4 billion is certainly less than three-tenths of a percent of public and private expenditures for children.

Given these comparisons, an obvious question is whether the Nation's investment related to child and adolescent R&D is consistent with our research investments to solve other social, economic, energy, transportation and health problems. Put another way, the estimated $2 billion investment is aimed at understanding the growth and development of 30 percent of the Nation's population--over 80 million children and adolescents under age 21. The lack of dramatic progress on some youth-related problems may stem from having limited R&D funding that must be spread across the spectrum of developmental prob lems arising during the first 20 years of life.

This research investment in children must address not only all developmental issues (social, emotional, cognitive and health) from before birth to age 21, but also a wide range of social issues (such as education, social services, and delinquency). In a ddition, this research seeks not only to address the developmental issues and problems which arise during childhood, but also to uncover the origins of health conditions that are manifested later in life but have their genesis and best hope prevention in childhood. The annual health care cost of four such conditions alone (atherosclerosis, osteoporosis, diabetes, and obesity) exce eds $100 billion.

Younger Americans may benefit from programs for which they are not specifically a target group. The funding for these programs, such as those directed toward general health and family research, is not included in the estimate of the amount directed expli citly at child research.

• Recognize the importance of basic, theory-informed, hypothesis-driven research on developmental processes. Fundamental research on developmental processes during the prenatal period, infancy, childhood, adolescence, and young adulthood should be a cornerstone of the child and adolescent research enterprise. Such knowledge provides an essential foundation from which to design programs, inform public policy, and conduct research on efforts to promote child and adolescent health. This research yields information that can help address not only problems that occur in childhood, but also those that do not appear until later in life but have their antecedents in childhood. Such health conditions include atherosclerosis, diabetes, osteoporosis, obesity, and some cancers.

• Understand a child's overall development over the long term. Research should address the relationships among biological, cognitive, social, and emotional aspects of human development over the life course. Though research is making strides in this regard (for instance, there are links between social and cognitive development research), insufficient efforts have been made to link cognitive, social, and emotional domains to biological factors. The multiplicative effects of risk factors are rarely considered. Our understanding of how the whole child develops during the first two decades of life, therefore, remains limited.

• Examine child and adolescent development in the context of their families and communities. A multidisciplinary research approach should create, improve, and sustain longitudinal studies of representative samples of all children over at least the first two decades of life and preferably into adulthood. (Minority and poor children have been the primary focus of problem-oriented research. They are too often neglected in normative developmental research, which typically focuses on children from white, middle-class families.) Such a long-term strategy will help to increase our understanding of how families, peers, schools, community organizations, media, and other social institutions together influence the totality of child and adolescent development. Recognition of multiple influences is critical to the design of programs and formation of public policy.

• Attend to "positive" outcomes for children and adolescents. Mission-oriented research, by definition, focuses on problems and deficits. For example, research efforts -- as well as policies and programs -- are often centered on health-threatening or compromising behaviors; comparatively few efforts examine health-enhancing behaviors. However, many children and adolescents do adopt positive behaviors and more attention is needed to find ways to help teens, families, schools, communities, and the media encourage such behaviors. Health promotion approaches are inextricably linked to knowledge about how key environmental and situational influences facilitate or hinder young people's efforts to ensure their health and well-being. Policies oriented toward helping more young people succeed will require knowledge about how health-enhancing behaviors can be achieved in diverse populations.

Illustrative Research Issues

During discussions to identify illustrative research issues, the Children's Initiative Subcommittee considered the following criteria: the nature and importance of an issue's impact on children, youth, families, and larger society; the degree of public concern about the issue; the extent to which the scientific community is prepared to advance knowledge of this issue; and the potential for improved research understandings to effectively inform policy (i.e., does a "policy window" of opportunity exist?).

Working from the above cross-cutting themes and principles, the Children's Initiative Subcommittee identified six research opportunity areas concerning the development of children and adolescents that merit further exploration in the next phase. These six areas are: (1) influence of families and communities on child and adolescent development, (2) health and behavior, (3) children and environmental hazards, (4) understanding learning, (5) policy research, and (6) longitudinal studies. An overview of each area follows, outlining current knowledge in this area, topics that need to be explored further, anticipated benefits of advancing the knowledge base, and suggestions for which Federal agencies could work together to act on these research opportunities. Taken together, the six research areas create a functional path that enables us to look at all facets -- biological, cognitive, social, and emotional -- of children's development.

These six research opportunity areas should be considered illustrative starting points for thinking about the Federal research investment strategy. They are not meant to be the final word on the Federal research agenda, nor do they represent an exhaustive list of all research questions that will inform policies and programs regarding young people's development. For example, two of the six issue areas -- policy research and longitudinal studies -- cut across the other four areas.

Research leading to reliable, useful indicators of child and family well-being is a key element of any research enterprise; however, this initiative did not address this element because it concluded that there was sufficient current activity in this area by the Federal Interagency Forum on Child and Family Statistics, Partnerships for Stronger Families, and the NICHD Child and Family Well-Being Research Network. Improved communication among these and other related public- and private-sector research efforts should be established to further enhance the knowledge base about children and adolescents.

1. HEALTH AND BEHAVIOR

Research has established that a number of personal behaviors are major determinants of long- and short-term health outcomes in children and youth. For instance, the initiation of unhealthy or risky behavior such as substance abuse (including tobacco use), drinking and driving, early or unprotected sexual intercourse, poor nutritional choices, lack of exercise, violence, not wearing safety belts, and not using bicycle and motorcycle helmets is related to poor outcomes during early adolescence and beyond. Given this knowledge, the Federal Government collects information to indicate the general health and well-being of children and youth. The Youth Risk Behavior Survey, for example, monitors serious health-risk behaviors (e.g., unintentional and intentional injury, tobacco, alcohol and other drug use, sexual behaviors, dietary behaviors, physical activity) that contribute to the leading causes of mortality, morbidity, and social problems among young people.

What We Need to Know. Major strides have been made during the past few decades in understanding how health problems of children and youth develop, but the following gaps in our knowledge, while not an exhaustive list, remain:

• What influences children and adolescents to avoid or engage in risky and adverse behaviors? To increase the likelihood of healthy youth and adult development we must better understand what prevents young adolescents from engaging in adverse behaviors in the first place. If they do adopt risk-taking behaviors, what influences them to do so and how can such actions be effectively modified? This requires a more advanced understanding of (1) the factors that influence negative risk behaviors -- for example, the incentives within a child's or adolescent's environment that serve to sustain these behaviors; and (2) the factors that influence positive, healthy behaviors and the conditions in which such factors thrive. Knowledge about how to strengthen and maintain the impact of positive forces in young people's lives is essential to development of policies and programs that facilitate health-enhancing behaviors.

• What is the nature of the health behavioral change process for children and youth? Research is needed not only to capture what contributes to health-compromising and health-promoting behaviors, but also to understand the process of behavioral change in children and adolescents. Existing models of health that are related to behavioral change have focused mainly on adults. Very little is known about behavioral change for young people, for whom the process may be even more complex given the wide variation in child and adolescent developmental levels.

• To what extent does maternal nutrition influence whether a child will develop chronic diseases later in life? The influence of maternal nutrition on fetal brain development, hormones, and blood supply has enormous public health implications. However, little is known about the effects of a specific micronutrient deficiency-macronutrient imbalance or overconsumption of calories during pregnancy on the development of chronic diseases in later life.

• What are the cumulative effects of adverse and risky behaviors on child and adolescent development? Research is needed that looks beyond specific problems of injury, violence, delinquency, teen pregnancy, substance abuse, and other risky behaviors in isolation to consider how these problems intersect and connect. For instance, knowing whether common behavioral mechanisms are contributing causes of multiple health risks would provide the basis for developing more effective intervention strategies. There is a need for research on the social, cultural, and behavioral factors influencing "risky behaviors" which result in trauma injuries to children and youth. Transportation- related examples include (1) drinking and driving, (2) failure to wear bicycle or motorcycle helmets, and (3) improper use of, or failure to use, child restraint systems or seat belts.

• How do health risk behaviors compare among different age groups? The majority of research conducted and data collected on youth and health-risk behaviors focuses on older adolescents. Our capacity to monitor younger children's health and well-being is currently limited -- especially in the areas of social and behavioral development. Information is very much needed on such development for different age groups, especially middle childhood. Such research will help to inform the timing of intervention strategies. Although it may be more difficult, the optimal time to study children in relation to health-risk behavior is during the transition from middle childhood to the teen years. To teach children about the potential effects of current behavior and help them develop the necessary skills to avoid engaging in risky behavior requires more extensive knowledge about social relationships that children form during middle childhood and the influence that peers and the media can have on experimentation and acquisition of adverse or positive health behaviors. The contribution of gender, ethnicity, and socioeconomic status to understanding age-related development should also be considered.

• How do environmental, family, and situational influences affect child and adolescent health-risk behaviors? Research shows that how parents interact with their children can affect the extent to which young people are initiated into risky behaviors. Research is needed to identify the most effective strategies families can use to support their children's healthy development. This is particularly true during middle childhood, when parents can play a critical protective role in guiding children's acquisition of healthy behaviors. Research is also needed on the effects of other environmental and situational influences -- such as the media and popular culture, peer groups, schools, and community organizations -- on the health-risk perceptions and behaviors of children and adolescents. All of these influences are potential tools in designing effective health promotion approaches.

• How do children and adolescents perceive the risks of engaging in health-compromising behavior and what approaches would help them to adopt more health-enhancing behavior? Though most youth who engage in health-compromising behavior understand the long-term consequences of their actions, they may not consider such repercussions relevant and, therefore, are unlikely to change their behavior. Research which takes into account different socioeconomic backgrounds and different ethnic or racial groups should address questions related to children's understanding of potential risks and outcomes. Such research should also explore their developmental capacities to perceive relationships between their actions and the short- and long-term consequences. For example, children who smoke do not consider the long-term consequence of cancer to be as relevant as the short-term consequences of peer acceptance, and the effect of smoking on breath and teeth. For some, immediate social acceptance may be a more powerful influence than poor health, especially if it occurs during their adult years.

How Federal Agencies Conducting Research Could Work Together in this Area. The NIH Office of Behavioral and Social Sciences Research is playing a major coordinating role across the NIH to assure that the behavioral aspects of health are well integrated into the Nation's health research enterprise. The National Science Foundation (NSF) supports disciplinary research on the cognitive and decision-making underpinnings of risk perception and behavior. At the same time, other agencies of the Federal Government such as the CDC, ED, USDA and the U.S. Department of Transportation (DOT) are engaged in efforts to promote health and prevent disease and injury. The U.S. Department of Justice (DOJ) supports programs and approaches to prevent and treat violence, now considered a major threat to public health.

Research findings have now established that problematic outcomes in child and adolescent health do not occur in isolation from one another. Health-compromising behaviors, such as poor diet, smoking, and inadequate exercise and fitness, tend to cluster in the same individual. Likewise, health-enhancing behaviors, such as regular use of seat belts, and avoidance of harmful substances such as tobacco, also tend to cluster. This line of evidence indicates that child and adolescent health and behavior initiatives in the future must involve agencies, that, heretofore, have focused on specific health outcomes.

2. CHILDREN AND ENVIRONMENTAL HAZARDS

The Federal Government (including the Environmental Protection Agency (EPA), the National Institute of Environmental Health Sciences (NIEHS), the CDC, the Consumer Product Safety Commission (CPSC), the Agency for Toxic Substances and Disease Registry (ATSDR), and the Department of Housing and Urban Development (HUD)) has made important contributions to answering some of the questions concerning the effects of environmental hazards on children. These activities range from basic research to systematic evaluations examining whether environmental protection efforts are adequately safeguarding children's health. The EPA has recently proposed new pesticide and chemical testing guidelines to more completely identify neurological, developmental, and reproductive effects on children.

What We Need to Know. Through research on the risks associated with exposure to environmental hazards, significant gains concerning the health and well-being of children and adolescents have been made. Yet much more can be done to protect children from environmental health hazards. Questions that require further exploration include:

• How can we improve the identification of and response to environmental threats to children's health? Although progress has been made toward quantifying the risk environmental hazards pose to children, our ability to identify environmental threats to children's health and then develop effective strategies to address them must improve. While a great deal is known about some hazards, researchers are just beginning to understand others more fully. For example, increasing scientific attention has been focused on the potential effects of synthetic chemicals on the hormone system. These chemicals -- known as endocrine disruptors -- may pose a major hazard to children. A number of chemicals, including organochloride pesticides such as DDT and chemicals such as PCBs, can cause endocrine disruption in wildlife and laboratory animals. Because very low levels of chemicals that block or mimic reproductive and thyroid hormones can determine the course of prenatal development, there is substantial concern about the potential for birth defects and alterations of normal growth and development in children from suspected endocrine disruptors. The NSTC Committee on Environmental and Natural Resources (CENR) has established a committee to coordinate endocrine disruptor-related research throughout the Federal Government.

• How can we prevent cumulative exposures to a hazardous substance from multiple sources? Even if risks from a chemical are known, it is difficult to reduce these risks when the exposures occur from unrelated sources, particularly when the chemical accumulates in the body. The most effective approach is for agencies to address the problem in a coordinated and comprehensive program. As an example, lead from leaded gasoline, paint, industrial processes, soil, food, water, dust, certain consumer products such as miniblinds, and toys are sources of lead exposure to children. Individually, some of these exposures are adverse; others are not. However, since lead and lead damage is cumulative in the body, the sum of exposures adds to the body burden and increases the risk of toxic effects. Agencies took a holistic advisory and regulatory approach to prevent hazardous lead exposures from multiple sources. The Federal Lead Paint Task Force, consisting of some 20 different Federal regulatory and advisory agencies, and public and private groups, informed and organized childhood lead poisoning prevention activities. Partnering of public and private efforts, such as the National Lead Information Center (800-424-LEAD), can bring expertise and resources together to address specific lead exposure concerns from a variety of sources. The total success is reflected in the reduction of the average blood lead level for young children in the United States to 3.6 ug/dl from a late 1970s high of 15.0 ug/dl.

• What are the cumulative effects of hazardous substances? Even when there is sound information about specific hazardous substances, very little is known about their cumulative or synergistic effects. Traditionally, most environmental protection regulations examine risks on a chemical-by-chemical basis, although in reality people are exposed to multiple substances at the same time. For example, the National Academy of Sciences (NAS) report, Pesticides in the Diets of Infants and Children, identified this single-chemical approach to regulation as a major shortcoming in the Federal pesticide and food safety regulatory system, particularly as it relates to children. Responding to concerns expressed in the report, pesticide and food safety laws were recently amended, mandating that EPA assess ?aggregate exposure? to pesticide residues, including all sources of exposure to chemicals with a common mechanism of action, when determining safe levels of pesticides on food.

• What kinds of hazards are those to which children are most sensitive, and why? While it is clear that children are more vulnerable to environmental hazards in general, more detailed information is needed. For example, while children are often more susceptible to environmental threats because their immune, neurological, and other systems are still developing, it is not known to which hazards children are more sensitive, or why.

  Also, children face physical hazard susceptibility regarding motor vehicle-related injuries because they have smaller bodies, and because adults may direct where they sit and may decide whether safety devices are used. Motor vehicle-related injuries are the major cause of death for those ages five to 27.

• When are children most vulnerable to environmental hazards? Further research is needed to identify windows of particular vulnerability to environmental hazards. Children move through several stages of rapid growth and development throughout infancy and adolescence, during which they may be especially sensitive to the effects of exposure to toxic substances. Research is needed to help identify these windows of heightened susceptibility in order to focus environmental protection efforts on the highest risk exposures and on outcomes with the greatest potential effects on normal intellectual and physical development.

How Federal Agencies Could Work Together in this Area. Effective partnerships are required to achieve a healthy environment for children. Federal agencies charged with protecting public health and the environment must work together to achieve desired outcomes for young people. One such collaborative effort might be the development of public health guidelines on environmental issues to improve children's health. The ATSDR provides a written series for this purpose. The EPA develops testing and risk assessment policies for environmental pollutants.

A potential opportunity for collaboration within HHS is a recently established Subcommittee on children and environment. The subcommittee, convened by the HHS's Environmental Health Policy Committee, is charged with coordinating the activities of relevant HHS agencies conducting work in this area. Other agencies such as EPA, the Department of Energy (DOE), and CPSC have been invited to be liaisons to this activity.

Another potential coordinating point is EPA's Children's Environmental Health Initiative. One EPA proposal is to fund academic institutions to advance the understanding of how children are exposed to environmental hazards and children's susceptibilities and vulnerabilities to environmental hazards. The EPA has committed to establish two national Centers of Excellence on Children and Environmental Health in academic institutions. Such an endeavor could be undertaken as a partnership by several Federal agencies. For example, the USDA provides data to the EPA to help monitor and establish estimates of exposure to pesticide residues in foods. The agencies are currently working together to obtain additional data specific to infants and children.

An existing hub for research coordination is the NSTC CENR. The Subcommittee on Risk Assessment has provided a powerful stimulus to standardizing and coordinating the approaches of all Federal agencies to health and environmental risk assessment, and assessment-related research. The CENR Subcommittee on Toxic Substances coordinates research on these topics.

The ATSDR Child Health Initiative, launched in 1996, has focused the agency's programs and public health actions on reducing the adverse effects of toxic substances on the health of infants, children, and youth. This initiative is intended to (1) place a special emphasis on child health issues, (2) implement new projects that benefit children and their families, and (3) solicit input and disseminate information through other government agencies, professional organizations and child advocacy groups.

3. UNDERSTANDING LEARNING: STUDIES ON COGNITION,
DEVELOPMENT, AND LEARNING TECHNOLOGIES

Currently, the NSF, the ED, and the NIH all support research related to cognitive development and learning. Enhanced research investments that build upon the convergence of concepts, models, and technologies used in many related disciplines have the potential to yield significant benefits for learning research. Disciplines that contribute to the study of learning in natural and artificial systems, and to the techniques and methodologies for supporting enhanced learning include the social and behavioral sciences, mathematics and the physical sciences, and education and cognitive sciences. An interagency research focus could build on all of the strengths of different participating agencies, capitalizing on ongoing research efforts, fostering cooperation, and highlighting interdisciplinary approaches that offer the highest potential to serve our Nation's education and human resource needs.

What We Need to Know. Science has already demonstrated that the importance of learning and creativity in the first two decades of life cannot be underestimated, yet our knowledge base is limited. Many questions still remain.

The examples cited here are not meant to be exhaustive. They represent research needs that could be more capably addressed through interdisciplinary approaches. The unique contributions and research strengths of each agency are important to address these issues.

• Studies on learning disability. The following themes will support ongoing and enhanced research on how to bypass physical or mental impairments which can limit learning.
  • Basic research on brain function, neural networks, and learning models to improve understanding of the causes and implications of certain learning disorders.
  • Basic research on brain adaptability and compensation to overcome dysfunction.
  • Research on technologies that facilitate learning and help children to overcome problems associated with learning impairment.
  • Research on mental or environmental stresses that result in impaired learning capability.
  • Research on basic processes or environments that facilitate and enhance natural learning processes, including the creation of effective learning tools that support and guide individual learning for people of all ages in various settings.
  • Testing and evaluating different learning models and approaches in applied settings.

• Learning at Higher Levels. Research approaches have the potential to yield important results with respect to an individual's ability to learn in meaningful ways. Interdisciplinary research to enhance children's ability to think critically, process, and communicate information will depend upon research gains on the following topics.
  • Understanding of selective attention and memory management in learning systems.
  • Development and testing of information management tools based on combined insights from neuroscience and cognitive science with methods employed by mathematical scientists, engineers, biologists, biochemists, and psychologists.
  • Research on basic cognitive development and successful techniques to promote higher learning.
  • Research on mental representations and memories including how they are constructed, selected at a given moment, and accessed to solve novel problems.
  • Development and application of technological tools to enable higher learning and enhanced memory capability.

Many other problems and issues associated with supporting and maximizing learning potential similarly require interdisciplinary approaches and understanding. Research on basic cognition, approaches to learning, and limits and enhancements to learning abi lity will be generalized to other educational and workplace challenges individuals face into adulthood.

• What effect do multimedia technologies have on children's development? Computers and technology are fast becoming a part of everyday life for children and adolescents, both in and out of school. Yet little is known about how powerful, multimedia technologies and the images they produce affect the information processing, knowledge and decision-making skills of children. Understanding of the effects of the mass media and electronic marketing (e.g. Internet) on health-compromising choice s such as inadequate diet and exercise, smoking, alcohol and drug use remains limited, yet is potentially critical to efforts to improve health practices.

• What is the role of nutrition in enhancing a child's ability to learn? Research findings suggest that nutrients play an important role in the brain functioning and cognitive development of children and adults. Additional research is nee ded to define the role of key nutrients in neurological function to understand how diet affects development during gestation and early developmental stages, and what nutrients are required for optimal cognitive development and peak functioning. Understand ing what nutrients result in improved cognitive functioning throughout life would have important bearing on policy development regarding nutritional requirements during early development and beyond.

• What are the effects of childhood head injury on learning and intelligence? Head injury is a leading cause of accidental death and disability among children. Studies have shown that children under the age of 14 years are more likely to sustain head injuries than adults, and that children's head injuries are often of increased severity. Despite the high incidence of head injury among children, studies addressing mechanisms of injury, recovery from injury, and impact on learning and int elligence are lacking. Development of head injury models that allow meaningful predictions of severity of head injuries related to a wide variety of sports and recreation-related children's activities is needed. Also, models are needed that can differen tiate abuse-related injuries from head injuries due to falls.

How Federal Agencies Could Work Together in this Area. Different agencies of the Children's Initiative have unique capabilities and strengths with respect to research on learning. Working together, the potential for advances in theory and application is heightened. Transferability of data and methods to classrooms and other learning sites will also be improved.

The NSF has unique capabilities with respect to interdisciplinary research in this area since it supports basic research on all of the science and engineering fields involved in the study of learning. In 1996, NSF initiated an activity, Learning and Inte lligent Systems (LIS), that will fund high-risk, multidisciplinary basic research and technology development on the learning processes in humans, and in artificial systems. Though LIS does not focus specifically on children, the initiative contributes di rectly to the understanding of learning and cognitive development generally, including the development of prototype technologies to support and enhance higher-level learning. The research methods employed will also have broad applicability to other resea rch on children. NSF has focused this activity on integrating technology with research and on exploring unifying concepts in the many disciplines that contribute to the study of learning and intelligent systems. LIS's research focus recognizes that advan ced information and communication technologies are radically transforming the way people will live, learn, create, and work in the 21st century, and responds to the need to provide supportive technologies that enhance the human ability to learn and create . In addition to the LIS program, NSF also supports basic research in social and behavioral sciences, biology, and other related fields. Through enhanced support, large-scale testing and implementation projects could be initiated; research initiatives c ould be accelerated.

The NIH also has unique capabilities for funding and conducting research on all aspects of the health sciences, including neurosciences and environmental health effects. Basic research on brain function, pathways, and brain disorders is ongoing at NIH la bs and through research grants. With respect to research on learning disabilities, NICHD-sponsored research on dyslexia has recently resulted in new techniques for diagnosing and treating the disorder. Other interdisciplinary, large-scale, and collabora tive research projects would be more feasible with enhanced support and cooperation with other agencies.

The ED funds research targeted specifically at education and learning, including process evaluation and models, methods and technologies for learning. Direct involvement of the ED in basic and applied research on learning promises rapid advances in both theory and application. Working together with other agencies of the Children's Initiative which focus on more basic research understanding, the ED has much to offer and gain from interdisciplinary and collaborative efforts.

The Department of Defense (DoD), with both its research and educational programs, could be an important partner in such an effort, given its work in information technology as well as human capital development. The DoD also is expert in the applicability of advanced simulation and presentation techniques, such as virtual reality, to other instructional settings. This work could be applied in the transportation sector for example, the applicability of simulator technology to driver education.

4. INFLUENCE OF FAMILIES AND COMMUNITIES ON
CHILD AND ADOLESCENT DEVELOPMENT

Research involving infants, for example, is identifying how their interactions with responsive caregivers (parents and other adults) provide the foundations for developing a healthy sense of self, forming trusting relationships, and taking pleasure in lea rning and exploring the world.

Research also is documenting the importance of children's direct interactions in middle childhood and adolescence with their parents as well as with mentors and peers. Findings are shedding new light on important variations in parents? and other adults? abilities to structure and influence children's access to and use of resources -- human and institutional -- in their communities. Such adult mediation of the community influences children's involvement in positive experiences or in high risk behaviors s uch as substance abuse and violence.

There also is new evidence of the importance of building networks of relationships that provide an expanding circle of support for both child and family. Research results on early intervention strategies to promote responsive caregiving and healthy infan t development underscore the importance of focusing on both child and family development (i.e., a two-generational strategy), and attending to the role of community conditions and resources. Studies involving families with similar signs of stress indicate that lower child maltreatment rates are associated with the presence of community supports (e.g., churches, Boys and Girls Clubs, school-based community programs). In addition, findings show that parenting practices known to be effective in communities in which there are many resources and few problems are not as effective in communities in which conditions undermine parents' goals, expectations, and interactions with their children. As demographic changes bring about greater cultural diversity, studies are beginning to map both the similarities and the differences among cult ural groups in the ways that family and community influence children's lives.

This growing knowledge base is beginning to stimulate a broad range of policy approaches that emphasize working with families and communities to provide children and adolescents with the social networks and supports they require to make a successful trans ition into adult life. For instance, research has played a vital role in the design and implementation of the new Early Head Start program. Based on principles drawn from research on service delivery, Early Head Start enables communities to design flexi ble and responsive programs to provide comprehensive child and family support services to low-income families with children under the age of three. Longitudinal research is built into the program to generate knowledge that can be used both to improve ser vices and to assess impacts on children, their families, and their communities.

Further, projects supported by the National Institute on Drug Abuse (NIDA) are applying knowledge about childhood predictors of drug use to the development and refinement of preventive interventions that focus on involving schools, families, and peers. I n another example, the Centers for Disease Control and Prevention (CDC) is developing Human Immunodeficiency Virus (HIV) interventions involving at-risk adolescents and their parents based on research that shows that strengthening familial communication i ncreases the likelihood that adolescents will adopt HIV risk-reduction behaviors. Also, CDC is documenting the positive role of comprehensive school-based health education in influencing the health-risk behavior of adolescents.

What We Need to Know. Given the challenges facing our families and communities, it is essential to build on our current knowledge base and focus on how changes in families and communities can be harnessed for the benefit of children, taking into account gender and racial/ethnic variations. Here are several pressing questions for which answers are needed:

• How do families and children (or youth) access community resources? There is limited knowledge about how community-based support structures are established and how families and children (or youth) access available resources. In addit ion, scientific information is limited about how contemporary media and popular culture influence children and youth and what that means for how families, community groups, and others should interact with youth to convey important information about their health, education, and well-being. Little is known, for example, about when, where, under what conditions, and at what ages various communication strategies are effective with differe nt child and adolescent groups. Likewise, further information is needed about how the availability of transportation transforms the perception of the resources that are "accessible," and those which are not.

• How do different components of the community contribute to the development of self-protective safety behaviors in children and adolescents? Understanding the roles played by parents, caregivers, preschool and school teachers, coaches, o lder siblings, peers, and others in the development of safe behaviors could lead to strategies to foster development of such behaviors early in life. Longitudinal behavioral studies that assess relevant characteristics and influences of these groups of people on the development of safe behaviors in children are essential to the development of sound policies and program s.

• How can communities facilitate an adolescent's safe passage to adulthood? This transition cannot be understood without linking adolescence to development that occurs during early and middle childhood. Thus, longitudinal research that ca ptures individual development over time and also assesses the characteristics and influences of families and communities is essential to advance our knowledge and better inform policy and practice.

• How are families and communities changing and how does such change positively and adversely affect children and adolescents? The scientific literature strongly suggests that instability in the lives of children and adolescents can adver sely affect their development and well-being. Research indicates that frequent changes in residence, childcare arrangements, or the adult composition of the household can prevent children and adolescents from establishing stable relationships with adults and peers. Children undergoing such changes may also lack supervision in their homes and communities. Observed results should be explored for their utility in policy interventions. It is also critical that we understand the dynamics of positive change s in communities and neighborhoods.

• How are children, families, and communities affected by major policy innovations now taking place at national, State, and local levels (e.g., in health care delivery, family income support, and economic self-sufficiency)? For example, p rovision of income support by the States (rather than by the Federal Government) may result in powerful policy incentives that induce impoverished families to change their residence and household structure frequently. These changes could occur because of the availability of State funding, time-limited benefit structures, and different programs that might arise out of welfare experimentation at the State and local levels. Such residenti al mobility will challenge research on welfare reform experiments at the local level. It will require tracking changes in residence and how those changes affect children. Longitudinal designs that are robust enough to account for these changes over time and a diversity of State and local policies are needed to evaluate adequately the effects of welfare experiments at the State and local levels and to support States in developing welfare policies that enhance child and adolescent development while preven ting serious problems.

• How do policy choices regarding physical infrastructure and urban and rural economic development affect children? While about 70 percent of this country's poor live in central urban or rural areas (U.S. Bureau of the Census, March Curr ent Population Survey, 1995) most job growth is occurring in the outer suburbs, resulting in a spatial mismatch between jobs and poor people. Research should include efforts to analyze: (1) the importance of transportation and mobility for children's and families? overall well-being, and (2) how lack of access to residential transportation may hinder c hildren's and families' social, educational, and emotional development.

How Federal Agencies Could Work Together in this Area. Researchers and those involved in esigning preventive programs share an interest in family and community support for children and adolescents. These support systems are often referred to as ?contexts? for development to be understood in their own right and for engaging families and communities in facilitating positive outcomes in young people. Thus, a broad range of Federal research agencies is now supporting projects in this area. T he ED for instance, is providing support through (1) its research institutes that aim to connect families and communities in supporting the optimal educational achievement of children, and (2) its reorganized elementary and secondary education programs wh ich confer a greater decision-making role at the school level in exchange for accountability for higher student achievement. Other agencies involved include HHS through its research and prevention programs, including comprehensive community-based health promotion programs in substance abuse, mental health, and cardiovascular health; and the CDC through its efforts to promote health and prevent violence and diseases.

Collaborations among these research agencies, especially those that strongly connect educational and health outcomes in children and adolescents, are needed. Young people who are healthy are more likely to benefit from educational opportunities. Likewis e, research shows that children and youth who are doing well in school and have supportive families are more likely to engage in health-enhancing behaviors (and less likely to engage in those risky to their health) than are those who are doing poorly in school.

5. LONGITUDINAL STUDIES

What We Need to Know. Longitudinal studies provide a mechanism for understanding what factors are most important in influencing a child's life course. Such knowledge is essential in ensuring that all children grow up to be healthy and cont ributing adults, thereby reducing significant medical and social costs associated with adverse outcomes. Here are several longitudinal studies that could help us achieve this knowledge:

• How does children's development in normal conditions compare to what occurs in adverse conditions? A major gap exists between our understanding of how children develop in normal conditions and what happens to children who are at risk be cause of abuse and neglect, homelessness, institutionalization, violence, criminal activity, and other adverse conditions. It is important to conduct studies that bridge this gap to increase our knowledge of why some children manage to overcome these disadvantages and go on to lead productive lives.

• How can families and social institutions help children acquire the values, motivation, knowledge and skills to become socially responsible and productive adults? Recent advances in the biomedical, social, and behavioral sciences now enable the design of longitudinal studies that can inform how to optimize ch ildren's potential as they make the transition to adulthood. This requires a better understanding of how children prepare themselves for the working world, manage their activities, perceive and manage risks, and develop time-use skills in ways that facilitate their productive capabilities. A longitudinal study integrating multiple scientific disciplines would allow biological, psychological, social, and anthropological perspectives of child development to be blended with an economic framework of human capital investments in children by families and society. Research has progressed and such studies are feasible. Further, we, as a nation, hav e come to realize how much our future depends on developing our children's potential to its fullest.

• How do various childhood experiences affect later adult behavior? Great Britain has pioneered a special type of longitudinal approach called a birth cohort study, in which a large, population-based sample of newborn children is identifi ed and followed for several decades into adulthood. This type of study has been very successful in connecting biomedical, behavioral, and social information to develop a comprehensive portrait of how childhood experiences help shape later adult behavior and outcomes. Recent scient ific advances also suggest birth cohort studies may be an effective approach for understanding why children's developmental processes may differ across ethnic and socioeconomic groups -- an area in which there are currently few answers. Birth cohort studies also hold promise for assessing the neurocognitive effects of psychotropic agents (e.g., Prozac, Valium) on fetal and postnatal brain development and other structures and functions, as well as the impact of nutrition and environmental toxins and e xposures, during and after pregnancy. Longitudinal studies may help us to better understand the factors in childhood that contribute to safe or unsafe driving behavior, particularly drinking and driving, and use or failure to use seat belts and child restraint systems. Such studies could also determine impact of childhood injuries (e.g. head injuries) later in life. Many nations around the world have or are planning to launch simil ar studies. If the United States conducted a comparable study, a cross-national database for understanding child and adolescent development under different and similar social and economic conditions would be possible.

• What kinds of childhood and adolescent interventions are most effective in preventing adverse health behaviors? Many diseases or health-threatening conditions affecting adults have their origins during the perinatal period and in childh ood. Preventive measures can be most effective if interventions take place during these formative years. Longitudinal studies are needed to study interventions on representative populations over time to test their effectiveness, which may not become apparent until years later. A Children's Health Study could address some of the highly significant, long-term health issues in children that can be resolved only in longitudinal studies. Such a study would be analogous to the Women's Health Initiative, which was initiated because no long-term studies on a representative group of women had been done to assess adequately the effects of hormone replacement therapy on osteoporosis, breast cancer, and heart disease; or the effect of reducing dietary fat on breast and intestinal cancer. The lifetim e benefits of knowledge gained from such studies in children would be significant.

  A Children's Health Study involving several different cohorts could explore in greater depth the effectiveness of a number of major preventive intervention issues including: strategies to increase children's calcium intake and prevent osteoporosis, dieta ry and exercise measures to reduce the risk of adult cardiovascular disease, therapeutic and other interventions to prevent obesity (one of the most prevalent adverse health conditions in children today), effective injury prevention programs (including motor vehicle injuries), individual and community-based interventions to prevent teen smoking, identi fication and intervention programs for children with mental health disorders, and newly developed education interventions to help children with learning disabilities.

  An emerging area is research on preventive interventions in areas including accidents and injury, substance abuse, adolescent pregnancy, youth violence, and obesity. Studies demonstrate that reducing substance abuse by young people requires more than pro viding information about the dangers of drugs. Information must be supported by teaching young people skills to resist peer influence and providing timely booster sessions throughout the high school years to sustain those initial sessions. Comprehensive community-based health promotion strategies that involve parents, local organizations, and the media indicate that multi-level interventions can be effective in preventing substance abuse, but must be sustained over time.

  A Children's Health Study, as an analogue of the current Women's Health Initiative, is one of the best ways to provide answers in the coming decades to many of the most pressing problems facing children today and in the future. Such a study would serve a s a highly visible sign of our Nation's commitment to its children. If the research portfolio on young people does not include longitudinal studies, the timing and content of health promotion and disease prevention efforts will not be as well informed by fundamental research on child and adolescent development as they must be.

How Federal Agencies Could Work Together in This Area. Longitudinal studies would greatly benefit from multiple agency involvement. Studies of vulnerable children are of interest to the Departments of Health and Human Services, Justice, Ed ucation, Commerce, the CPSC and the National Highway Traffic Safety Administration (NHTSA). Knowledge gained from birth cohort studies would be relevant to NIH, FDA, CDC, CPSC, USDA, and other agencies. Studies of learning disabilities could build on current interagency cooperation betwee n NIH and ED, which provides a useful model for these types of studies. The NSF-sponsored Panel Study on Income Dynamics (PSID) contains data on the impact of economic variables and conditions on child development and attainment.

6. POLICY RESEARCH

What We Need to Know. This is a critical time for researchers to assess how children and adolescents are affected by policy and regulatory changes. Major restructuring of longstanding social policies has the potential to affect large numbe rs of children and their families. Several reports have identified, with the participation of the research and policy communities, critical areas for policy research in income support, health care delivery, food assistance, educational attainment, and th e transition from school to work. Here are just a few cross-cutting examples of issues researchers are grappling with that have important policy implications:

• What are the effects of State-level variations in health care, welfare reform, and other services? For both health care and welfare reform, there is a need to ensure that State-level variations in implementation and outcomes are closely monitored and measured. In health care, changes in the financing system may affect not only access to health care, but also the nature and kind of care children and adolescents receive. Though welfare reform legislation provides States with greater fle xibility to redesign income assistance for families and children, it also establishes time limits and requirements for work participation that aim to change parents? responsibilities for supporting their families.

• What are the combined effects of policy changes on child well-being and what implications do they have on effective service delivery? Families will be affected by a combination of policies that respond separately to basic needs for food, health care, housing, safe neighborhoods, quality child care and schools, and a relia ble source of income. Policymaking must be informed by assessments of the combined effects of these changes on child well-being. State governments and other groups are seeking better ways to respond to the needs of children and their families and are try ing out a variety of ways to integrate services through comprehensive State and community initiatives, systemic reform efforts, and other broad-based strategies. Because standard experimental methods are not always suited to studying changes of this scop e, the advancement of a broader array of research methods also needs to be a focus of policy research.

• How will investments made to meet societal infrastructure and mobility needs affect the development and attitudes of children in areas where these investments are made? Large-scale investments in physical or information infrastructure s ystems create basic, long-term changes in the perceived and actual well-being of the people living in or near the area where they are made. These impacts must be taken into account during the decision-making process that leads up to them. The following issues are particularly important to study:
  1. How Federal investments in transportation systems and other kinds of physical infrastructure can improve children's chances of growing up healthy and productive, particularly in central urban and rural areas with limited access;

  2. How national transportation and infrastructure policies can support Federal welfare reform, health care improvement, and other major national quality-of-life goals; and,

  3. How Federal policies dealing with economic growth, transportation, and infrastructure investment influence State, local, and private-sector decisions and priorities regarding land use, education and health care, and community development.

• What prevention and intervention models will best foster the health and well-being of children and adolescents? Research is needed not only to identify when prevention and intervention approaches to prevent problem outcomes should take place, but also to determine how effective such approaches are in redu cing problem outcomes. In addition, little scientific knowledge exists on what kinds of prevention and intervention strategies work best and the extent to which approaches must be tailored for different groups of children and youth to be effective. Yet another important area of research that needs to be explored regarding prevention and intervention is the cost-effectiveness of different strategies.

• What data sources will enable us to monitor and assess how changes in key areas of health and safety, human services, education, and other sectors affect children and adolescents? A potential strategy for organizing Federal research in this area would be to focus on identifying and, as needed, creating the data resources to achieve at least the following: (1) establish national and State baselines for child and adolescent well-being on a core set of measures to provide data that enable the tracking of trends in child health and safety, education, and well-being; (2) establish State baselines for service provision by documenting, for example, how services are organized and delivered, and their effects on low-income children; and (3) desi gn and conduct child impact studies that have the methodological rigor to establish cause and effect relationships between policy and program changes and the health, safety, and well-being of children and adolescents.

  One possible starting point would be to enhance the National Health Interview Survey (NHIS) to be fielded by the National Center for Health Statistics (NCHS) of the CDC next year. These surveys yield national estimates of health status derived from both physical examinations and survey questions, medical expenditures and family formation, and they can be extended to some large States. An improved statistical system on children, youth, and families could be formed by building on the NHIS nucleus.

How Federal Agencies Could Work Together in This Area. Because effective approaches involve the delivery of services in many areas and yield multiple benefits for children and their families, Federal agencies and other groups should find it advantageous to partner in conducting new policy research on promising approaches. Where as the testing of new strategies requires funds not only to conduct research but to also develop and provide services, partnerships are likely a feasible route for overcoming the limitations of a given agency's area of authority or budgetary resources.

A multi-agency partnership effort could involve the HHS's health, social services and welfare research, the ED's research programs, the National Institute of Justice's juvenile justice research initiatives, HUD's research programs, USDA's research on food assistance programs, and education and training efforts undertaken by the Department of Labor.

Basic research is a first step -- a fundamental underpinning -- toward answering these and other questions and closing gaps in our knowledge about child and adolescent development. Indeed, theory-driven, applied and policy-related research efforts that address and build on the six opportunity areas identified in Section II are prime starting points. Advanced knowledge of family and community influences on children's behavior, for example, would help to determine what role families and communities can best play in shaping healthy lifestyle decisions regarding substance abuse, smoking, violence, nutrition, pregnancy and sexuality, and other risky behaviors. Exploring neurological and cognitive development at different ages with varying degrees and kinds of stimulation would also provide information about what kinds of learning situations facilitate optimal growth and development of the skills young people need to lead productive adult lives.

Knowledge gained in these and other areas can and should inform and facilitate action to address our Nation's urgent and costly social and economic issues. But for Federal research to be more effectively used in policy and program development, researchers must improve the ways in which they communicate and disseminate important findings to decision-makers. The scientific research community must work to establish new links and strengthen existing ones with policymakers and service providers. Likewise, policymakers and service providers, for their part, must not only assist researchers into identifying key research questions concerning children, youth, and families, but also must take responsibility for acting on relevant research findings. When successful, such connections can have powerful and beneficial results on children's well-being (see boxes in this section and additional examples provided in Appendix D).

Thinking About Linkages

Rather than viewing research linkages with policies and services as sequential in nature, these connections should be thought of in terms of a continuing feedback system, with multiple entry points for feedback and modification in the decision-maki ng process at the Federal, State, and local levels. Such a strategy would enable researchers not only to inform initial policy and program development, but also to monitor and evaluate the implementation of these policies and programs -- and their effect s on child, adolescent, and family status -- on an ongoing basis. Sustained research could provide knowledge that is essential in further shaping and refining policies and programs so that they more effectively address the problems facing our children an d Nation.

In thinking about how to create and sustain this continual feedback system, the broader landscape in which researchers, policymakers and service providers work must be considered. The very nature of this landscape suggests that a set of conditions must b e in place if successful linkages are to occur, and entry points and feedback opportunities are to be provided. Here are three examples of such conditions that illustrate the complexity of research-policy linkages; these are by no means exhaustive.

• Top Leadership. Fundamental to any successful linkage among researchers, policymakers, and those in direct contact with children and adolescents is the commitment of high-level Administration officials. Strong leadership is necessary t o creation of a climate in which scientific knowledge is perceived to be important and actually is used as an important factor in decision-making about policies and programs that affect the future of children, youth, and families. Within the Executive Br anch, coordination between the NSTC and the DPC on the scientific basis for policy initiatives concerning children and families must be strengthened through the creation of specific linkage mechanisms.

• Stronger Linkages with University Researchers and Professional Organizations. Universities and professional organizations are major sources of relevant research knowledge concerning child and adolescent development. As such, they must actively expand their efforts to build and strengthen links to those who develop policies and programs affecting children, youth, and families. In addition, universities have a special responsibility (and opportunity) to prepare future generations of res earchers so they can effectively connect research to policy and program development.

• Clear Lines of Communication with State and Local Policymakers and Service Providers. Lack of communication about, and dissemination of, knowledge are not problems limited to Federal agencies, university-based researchers, and professional organizations. It happens among others as well, most notably with those at the State and local levels who find themselves faced with new policy and program responsibilities, and a need for reliable knowledge to make informed decisions and effectively carry out these responsibilities. Not only are States, communities, non-governmental organiz ations, and others involved in service delivery important users of information, but they are also becoming important sources of critical data concerning child and family well-being in an era of devolution of human services. Establishing close linkages be tween universities and their surrounding neighborhoods and cities can be a way in which knowledge creation and utilization can be connected for mutual benefit, and for improving opportunities for children.

Linkages

In its effort, the Children's Initiative tackled the question of linkages from a specific perspective -- how the Federal research investment on child and adolescent development can be more effectively used to inform our Nation's domestic policy. The Chil dren's Initiative thus sought to answer these fundamental questions: How can we create and strengthen the linkage between two key agencies within the Executive Office of the President ? the NSTC (which coordinates the diverse parts of the Federal R&D enterprise) and the DPC (which overs ees the development and implementation of the President's domestic policy agenda)- in a way that fosters important research and policies? And how can this linkage create effective collaboration among and with other Federal agencies that support research on children and adolesce nts? Recommendations for how to establish and sustain such strong relationships are addressed in the next section.

Though the Children's Initiative was asked to focus solely on research-policy linkages at the Federal level, the group strongly urges similar linkages at the State and local levels.

A Need for Collaboration

Calls for more coordination and collaboration in research have been a consistent theme of public and private sector assessments of the research enterprise regarding children and youth. At this juncture, however, there are two compelling reasons why colla boration is even more critical than in the past.

First, the current fiscal climate requires more strategic use of existing Federal research dollars. As noted in Section I, the Federal Government currently bears primary responsibility for supporting research on children and adolescents. Yet Federal age ncies are working in an environment driven by constrained resources and public opinion that the Federal Government must scale back. Collaboration and strategic partnerships with other public and private sources are thus needed to leverage resources and m aximize their impact on research portfolios concerning children, youth, and families.

The boxes in this section on Partnerships for Stronger Families, the Federal Interagency Forum on Child and Family Statistics, and Research-Policy Linkages in Computing and Information Science and Technology provide insights and lessons for developing pro mising models of multi-agency collaboration and research-policy linkages.

One thing is clear: No one Federal agency can foster the scientific advances required to strengthen our Nation's investments in its children and youth. Coordination and strategic partnerships among Federal agencies are needed to leverage resources and m aximize their impact on the healthy development of the Nation's youth. What is more, the Federal Government alone cannot achieve these results; collaboration with other public and private organizations is essential.

To meet this challenge, the Children's Initiative Subcommittee recommends that an Interagency Working Group (IWG), such as the Task Force established in the Executive Order Protection of Children from Environmental Health Risks and Safety Risks, identify activities within their research portfolios that support, inform, and facilitate the achievement of the Administration's key goals of ensuring the optimal health, education, and well-being of all American children and youth.

The IWG will address priorities for multi-agency research activities concerning children, adolescents, and their families. Among the prime candidates for such activities emerging from the first phase are a children's health initiative to understand how c hronic health problems, which emerge in later life, can be better prevented; an effort to develop public health guidelines regarding environmental (including standards and regulations) interventions to reduce risks to safety and health among children; and a learning and technology initiative to understand how children learn in interaction with new, evolving technologies and how such technologies can be better designed to promote learning in schools and other settings.

The IWG's responsibilities should include, but not be limited to, the following:

1. Develop and implement a long-term strategic planning process - to advance a multi-agency Federal R&D effort related to the optimal development of children and adolescents. The six research opportunities presented in Section II can be used as starting points for this planning process. This process should include the identification and recommendation of appropriate partnerships among public (i.e., Federal, State, and local) and private sector parties (e.g., industry, private philanthropy) interested in ensuring the healthy and productive development of children and adolescents. The results of the strategic planning process should be presented to the President.

2. Identify key research investment opportunities regarding children and adolescents - to achieve the overarching goals outlined in the strategic plan. These investment opportunities should highlight the need for and the benefits of a multi-agency, coordinated approach in scientific research concerning young people. OSTP and OMB would play an integral role in working with the IWG to develop a coordinated strategy, including budgetary issues, in which agencies can collaborate on research problems of national concern. Thes e problems include strengthening the collection of reliable child and adolescent indicators and the research that provides us with the factors that influence these indicators over time. A coordinated research strategy on optimal human development from ea rly childhood into young adulthood, particularly on factors supporting learning and development knowledge, should be a high priority.

3. Identify mechanism(s) to strengthen research-policy linkages - not only among NSTC, DPC, Federal agencies and State and local government, but also among relevant non-governmental organizations and other public and private sector parties at the national, regional, and community levels. Such extensive linkages are needed to ensure that research knowledge generated by Federal agencies and other researchers is effectively used to inform policy and program development regarding children, you th, and families. The means for strengthening such linkages should occur on a regular, sustained, and timely basis.

4. Consider appropriate means for conducting an outside assessment of the IWG's work - to ensure that the Federal Government's strategic plan and identification of key research investment opportunities, potential strategic partnerships, and mechanisms for strengthening research-policy linkages regarding children and adolescents are on target. The IWG could, for instance, convene an Advisory Board of public and private sector experts from diverse disciplines or engage a relevant governmenta l or non-governmental entity to undertake this assessment.

A Final Note